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Sustained health-economic effects after reorganisation of a Swiss hospital emergency centre: a cost comparison study
  1. Klaus Eichler1,
  2. Sascha Hess1,
  3. Corinne Chmiel2,3,
  4. Karin Bögli2,
  5. Patrick Sidler2,
  6. Oliver Senn3,
  7. Thomas Rosemann3,
  8. Urs Brügger1
  1. 1Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
  2. 2City Hospital Waid, Zurich, Switzerland
  3. 3Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland
  1. Correspondence to Dr Klaus Eichler, Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, P.O. Box, Winterthur CH 8401, Switzerland; eich{at}zhaw.ch

Abstract

Background Emergency departments (EDs) are increasingly overcrowded by walk-in patients. However, little is known about health-economic consequences resulting from long waiting times and inefficient use of specialised resources. We have evaluated a quality improvement project of a Swiss urban hospital: In 2009, a triage system and a hospital-associated primary care unit with General Practitioners (H-GP-unit) were implemented beside the conventional hospital ED. This resulted in improved medical service provision with reduced process times and more efficient diagnostic testing. We now report on health-economic effects.

Methods From the hospital perspective, we performed a cost comparison study analysing treatment costs in the old emergency model (ED, only) versus treatment costs in the new emergency model (triage plus ED plus H-GP-unit) from 2007 to 2011. Hospital cost accounting data were applied. All consecutive outpatient emergency contacts were included for 1 month in each follow-up year.

Results The annual number of outpatient emergency contacts increased from n=10 440 (2007; baseline) to n=16 326 (2011; after intervention), reflecting a general trend. In 2007, mean treatment costs per outpatient were €358 (95% CI 342 to 375). Until 2011, costs increased in the ED (€423 (396 to 454)), but considerably decreased in the H-GP-unit (€235 (221 to 250)). Compared with 2007, the annual local budget spent for treatment of 16 326 patients in 2011 showed cost reductions of €417 600 (27 200 to 493 600) after adjustment for increasing patient numbers.

Conclusions From the health-economic point of view, our new service model shows ‘dominance’ over the old model: While quality of service provision improved (reduced waiting times; more efficient resource use in the H-GP-unit), treatment costs sustainably decreased against the secular trend of increase.

  • emergency department
  • primary care
  • management, emergency department management
  • management, cost efficiency

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